Provider Demographics
NPI:1063051597
Name:MILLER, MARIAN ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 BRIDGE ST FL 7
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5247
Mailing Address - Country:US
Mailing Address - Phone:516-534-5298
Mailing Address - Fax:
Practice Address - Street 1:397 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5292
Practice Address - Country:US
Practice Address - Phone:917-902-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-01
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023471103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical